BILL NUMBER: SB 188	CHAPTERED  10/10/99

	CHAPTER   900
	FILED WITH SECRETARY OF STATE   OCTOBER 10, 1999
	APPROVED BY GOVERNOR   OCTOBER 9, 1999
	PASSED THE SENATE   SEPTEMBER 10, 1999
	PASSED THE ASSEMBLY   SEPTEMBER 9, 1999
	AMENDED IN ASSEMBLY   SEPTEMBER 7, 1999
	AMENDED IN ASSEMBLY   AUGUST 26, 1999
	AMENDED IN ASSEMBLY   JUNE 28, 1999
	AMENDED IN ASSEMBLY   JUNE 9, 1999
	AMENDED IN SENATE   APRIL 6, 1999

INTRODUCED BY   Senator Leslie
   (Coauthor:  Senator Johannessen)
   (Coauthor:  Assembly Member Aanestad)

                        JANUARY 14, 1999

   An act to amend Sections 4056  4074, 4115, and 4116 of the
Business and Professions Code, relating to drugs, and declaring the
urgency thereof, to take effect immediately.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 188, Leslie.  Drugs:  hospitals:  physicians.
   Existing law generally prohibits any person from selling or
dispensing any dangerous drug, or dispensing any prescription, unless
he or she is a licensed pharmacist.  However, existing law permits a
licensed hospital that contains 100 beds or fewer and does not
employ a full-time pharmacist to purchase drugs at wholesale for
administration, under the direction of a physician, to patients
registered in the hospital or to emergency cases under treatment in
the hospital.  Existing law imposes criminal penalties for violations
of these provisions.
   This bill would revise the above-described exception to also
permit hospitals containing 100 beds or fewer to purchase drugs at
wholesale for dispensation by physicians to persons registered as
inpatients of the hospital, to emergency cases under treatment in the
hospital, or to outpatients of a rural hospital, as defined.  The
bill would impose specified restrictions on the dispensing of those
drugs to outpatients.  The bill would require rural hospitals, as
defined, to obtain information regarding the hours of local
pharmacies, as specified, and require specified hospitals that
contain 100 beds or fewer to obtain the services of a pharmacist
consultant to monitor and review the pharmaceutical services provided
by the hospital to inpatients of the hospital and the dispensing of
drugs by physicians to outpatients pursuant to the provision
described above.  It also would make related changes, including
expansion of requirements concerning adoption of a specified written
policy by health facilities.  To the extent that the bill would
expand the scope of an existing crime with respect to these
requirements, the bill would impose a state-mandated local program.
   Existing law authorizes a pharmacy technician to perform
nondiscretionary tasks only while assisting, and while under the
direct supervision and control of, a pharmacist.  Existing law
authorizes a pharmacy technician to perform these duties only under
the immediate, personal supervision and control of a pharmacist.
Existing law requires any pharmacist responsible for a pharmacy
technician to be on the premises at all times and requires the
pharmacy technician to be within the pharmacist's view, except when
the pharmacy technician is employed to assist in the filling of
prescriptions for an inpatient of a hospital or for an inmate of a
correctional facility.
   This bill would require, notwithstanding the above limitations,
that the California State Board of Pharmacy adopt regulations
establishing conditions to permit the temporary absence of a
pharmacist for breaks and lunch periods pursuant to a specified
statute and the orders of the Industrial Welfare Commission without
closing the pharmacy, during which time a pharmacy technician may
remain in the pharmacy but may only perform nondiscretionary tasks.
The bill would require the pharmacist to be responsible for a
pharmacy technician and to review any task performed during the
pharmacist's temporary absence.
  The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state.  Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   The bill would declare that it is to take effect immediately as an
urgency statute.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 4056 of the Business and Professions Code is
amended to read:
   4056.  (a) Notwithstanding any provision of this chapter, a
licensed hospital that contains 100 beds or fewer, and that does not
employ a full-time pharmacist, may purchase drugs at wholesale for
administration, under the direction of a physician, or for
dispensation by a physician, to persons registered as inpatients of
the hospital, to emergency cases under treatment in the hospital, or,
under the conditions described in subdivision (f), to persons
registered as outpatients in a rural hospital as defined in Section
124840 of the Health and Safety Code.  The hospital shall keep
records of the kind and amounts of drugs so purchased and
administered or dispensed, and the records shall be available for
inspection by all properly authorized personnel of the board.
   (b) No hospital shall be entitled to the benefits of subdivision
(a) until it has obtained a license from the board.  Each license
shall be issued to a specific hospital and for a specific location.
   (c) Each application for a license under this section shall be
made on a form furnished by the board.  Upon the filing of the
application and payment of the fee prescribed in subdivision (a) of
Section 4400, the executive officer of the board shall issue a
license authorizing the hospital to which it is issued to purchase
drugs at wholesale pursuant to subdivision (a). The license shall be
renewed annually on or before November 1 of each year upon payment of
the renewal fee prescribed in subdivision (b) of Section 4400 and
shall not be transferable.
   (d) The form of application for a license under this section shall
contain the name and address of the applicant, the number of beds,
whether the applicant is a licensed hospital, whether it does or does
not employ a full-time pharmacist, the name of its chief medical
officer, and the name of its administrator.
   (e) The board may deny, revoke, or suspend a license issued under
this section in the manner and for the grounds specified in Article
19 (commencing with Section 4300).
   (f) A physician himself or herself may dispense drugs to
outpatients directly pursuant to subdivision (a) only if the
physician determines that it is in the best interest of the patient
that a particular drug regimen be immediately commenced or continued,
and the physician reasonably believes that a pharmacy located
outside the hospital is not available and accessible at the time of
dispensation to the patient within 30 minutes of the hospital
pharmaceutical services or within a 30-mile radius from the hospital
pharmaceutical services by means of the method of transportation the
patient states that he or she intends to use.  The quantity of drugs
dispensed to any outpatient pursuant to this subdivision shall be
limited to that amount necessary to maintain uninterrupted therapy
during the period when pharmaceutical services outside the hospital
are not readily available or accessible, but shall not exceed a
72-hour supply.  The physician shall ensure that the label on the
drug contains all the information required by Section 4076.
   (g) A rural hospital, as defined in Section 124840 of the Health
and Safety Code, shall obtain information regarding the hours of
operation of each pharmacy located within the 30 minute or 30-mile
radius of the hospital.  The hospital shall update this information
annually, and shall make this information available to its medical
staff.
   (h) A licensed hospital that contains 100 beds or fewer, does not
employ a full-time pharmacist, and purchases drugs at wholesale for
administration or dispensation pursuant to subdivision (a), shall
retain the services of a pharmacist consultant to monitor and review
the pharmaceutical services provided by the hospital to inpatients of
the hospital, and the dispensing of drugs by physicians to
outpatients pursuant to subdivision (f).
   (i) This section shall not be construed to eliminate the
requirements of Section 11164 or 11167 of the Health and Safety Code.

  SEC. 2.  Section 4074 of the Business and Professions Code is
amended to read:
   4074.  (a) A pharmacist shall inform a patient orally or in
writing of the harmful effects of a drug dispensed by prescription if
the drug poses substantial risk to the person consuming the drug
when taken in combination with alcohol or if the drug may impair a
person's ability to drive a motor vehicle, whichever is applicable,
and provided the drug is determined by the board pursuant to
subdivision (b) to be a drug or drug type for which this warning
shall be given.
   (b) The board may by regulation require additional information or
labeling.
   (c) This section shall not apply to drugs furnished to patients in
conjunction with treatment or emergency services provided in health
facilities or, except as provided in subdivision (d), to drugs
furnished to patients pursuant to subdivision (a) of Section 4056.
   (d) A health facility shall establish and implement a written
policy to ensure that each patient shall receive information
regarding each medication given at the time of discharge and each
medication given pursuant to subdivision (a) of Section 4056.  This
information shall include the use and storage of each medication, the
precautions and relevant warnings, and the importance of compliance
with directions.  This information shall be given by a pharmacist or
registered nurse, unless already provided by a patient's prescriber,
and the written policy shall be developed in collaboration with a
physician, a pharmacist, and a registered nurse.  The written policy
shall be approved by the medical staff.  Nothing in this subdivision
or any other provision of law shall be construed to require that only
a pharmacist provide this consultation.
  SEC. 3.  Section 4115 of the Business and Professions Code is
amended to read:
   4115.  (a) Notwithstanding any other provision of law, a pharmacy
technician may perform packaging, manipulative, repetitive, or other
nondiscretionary tasks, only while assisting, and while under the
direct supervision and control of, a pharmacist.
   (b) This section does not authorize the performance of any tasks
specified in subdivision (a) by a pharmacy technician without a
pharmacist on duty, nor does this section authorize the use of a
pharmacy technician to perform tasks specified in subdivision (a)
except under the direct supervision and control of a pharmacist.
   (c) This section does not authorize a pharmacy technician to
perform any act requiring the exercise of professional judgment by a
pharmacist.
   (d) The board shall adopt regulations to specify tasks pursuant to
subdivision (a) that a pharmacy technician may perform under the
direct supervision and control of a pharmacist.  Any pharmacy that
employs a pharmacy technician to perform tasks specified in
subdivision (a) shall do so in conformity with the regulations
adopted by the board pursuant to this subdivision.
   (e) (1) No person shall act as a pharmacy technician without first
being registered with the board as a pharmacy technician as set
forth in Section 4202.
   (2) The registration requirements in paragraph (1) and Section
4202 shall not apply to a person employed or utilized as a pharmacy
technician to assist in the filling of prescriptions for an inpatient
of a hospital until July 1, 1997.
   (3) The registration requirements in paragraph (1) and Section
4202 shall not apply during the first year of employment for a person
employed or utilized as a pharmacy technician to assist in the
filling of prescriptions for an inmate of a correctional facility of
the Department of the Youth Authority or the Department of
Corrections, or for a person receiving treatment in a facility
operated by the State Department of Mental Health, the State
Department of Developmental Services, or the Department of Veterans
Affairs.
   (f) The performance of duties by a pharmacy technician shall be
under the direct supervision and control of a pharmacist.  The
pharmacist on duty shall be directly responsible for the conduct of a
pharmacy technician.  A pharmacy technician may perform the duties,
as specified in subdivision (a), only under the immediate, personal
supervision and control of a pharmacist.  Any pharmacist responsible
for a pharmacy technician shall be on the premises at all times, and
the pharmacy technician shall be within the pharmacist's view.  A
pharmacist shall indicate verification of the prescription by
initialing the prescription label before the medication is provided
to the patient.
   This subdivision shall not apply to a person employed or utilized
as a pharmacy technician to assist in the filling of prescriptions
for an inpatient of a hospital or for an inmate of a correctional
facility.  Notwithstanding the exemption in this subdivision, the
requirements of subdivisions (a) and (b) shall apply to a person
employed or utilized as a pharmacy technician to assist in the
filling of prescriptions for an inpatient of a hospital or for an
inmate of a correctional facility.
   (g) (1) The ratio of pharmacy technicians performing the tasks
specified in subdivision (a) to pharmacists shall not exceed one to
one, except that this ratio shall not apply to personnel performing
clerical functions pursuant to Section 4116 or 4117.  This ratio is
applicable to all practice settings, except for an inpatient of a
licensed health facility, a patient of a licensed home health agency,
as specified in paragraph (2), an inmate of a correctional facility
of the Department of the Youth Authority or the Department of
Corrections, and for a person receiving treatment in a facility
operated by the State Department of Mental Health, the State
Department of Developmental Services, or the Department of Veterans
Affairs.
   (2) The board may adopt regulations establishing the ratio of
pharmacy technicians performing the tasks specified in subdivision
(a) to pharmacists applicable to the filling of prescriptions of an
inpatient of a licensed health facility and for a patient of a
licensed home health agency.  Any ratio established by the board
pursuant to this subdivision shall allow, at a minimum, at least one
pharmacy technician for each pharmacist, except that this ratio shall
not apply to personnel performing clerical functions pursuant to
Section 4116 or 4117.
   (h) Notwithstanding subdivisions (b) and (f), the board shall by
regulation establish conditions to permit the temporary absence of a
pharmacist for breaks and lunch periods pursuant to Section 512 of
the Labor Code and the orders of the Industrial Welfare Commission
without closing the pharmacy.  During these temporary absences, a
pharmacy technician may, at the discretion of the pharmacist, remain
in the pharmacy but may only perform nondiscretionary tasks.  The
pharmacist shall be responsible for a pharmacy technician and shall
review any task performed by a pharmacy technician during the
pharmacist's temporary absence.  Nothing in this subdivision shall be
construed to authorize a pharmacist to supervise pharmacy
technicians in greater ratios than those described in subdivision
(g).
  SEC. 4.  Section 4116 of the Business and Professions Code is
amended to read:
   4116.  (a) No person other than a pharmacist, an intern
pharmacist, an authorized officer of the law, or a person authorized
to prescribe shall be permitted in that area, place, or premises
described in the license issued by the board wherein controlled
substances or dangerous drugs or dangerous devices are stored,
possessed, prepared, manufactured, derived, compounded, dispensed, or
repackaged.  However, a pharmacist shall be responsible for any
individual who enters the pharmacy for the purposes of receiving
consultation from the pharmacist or performing clerical, inventory
control, housekeeping, delivery, maintenance, or similar functions
relating to the pharmacy if the pharmacist remains present in the
pharmacy during all times as the authorized individual is present.
   (b) (1) The board may, by regulation, establish reasonable
security measures consistent with this section in order to prevent
unauthorized persons from gaining access to the area, place, or
premises or to the controlled substances or dangerous drugs or
dangerous devices therein.
   (2) The board shall, by regulation, establish conditions for the
temporary absence of a pharmacist for breaks and lunch periods
pursuant to Section 512 of the Labor Code and the orders of the
Industrial Welfare Commission without closing the pharmacy and
removing authorized personnel from the pharmacy.  These conditions
shall ensure the security of the pharmacy and its operations during
the temporary absence of the pharmacist and shall allow, at the
discretion of the pharmacist, nonpharmacist personnel to remain and
perform any lawful activities during the pharmacist's temporary
absence.
  SEC. 5.  No reimbursement is required by this act pursuant to
Section 6 of Article XIIIB of the California Constitution because the
only costs that may be incurred by a local agency or school district
will be incurred because this act creates a new crime or infraction,
eliminates a crime or infraction, or changes the penalty for a crime
or infraction, within the meaning of Section 17556 of the Government
Code, or changes the definition of a crime within the meaning of
Section 6 of Article XIIIB of the California Constitution.
  SEC. 6.  This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect.  The facts constituting the necessity are:
   In order to allow patients to obtain necessary medications and to
allow pharmacists to take temporary breaks without closing the
pharmacy, it is necessary that this act take effect immediately.
